A rare case of refractory ascites due to aortic regurgitation delaying peritoneal dialysis catheter removal after renal transplantation

Abstract

Introduction Removing the peritoneal dialysis (PD) catheter after transplantation is necessary in order to improve quality of life after transplantation. However, there is no consensus on the best timeframe of PD-catheter removal in transplanted patients. Early removal can lead to the absence of dialysis access in case of graft failure. However, late removal is associated with significant infectious risk given the immunosuppression. Herein, we describe an exceptional case of refractory ascites secondary to aortic regurgitation in a cirrhotic patient, delaying the removal of his PD catheter. Case reportWe describe the case of a 49-year old patient, with Child B cirrhosis and end-stage kidney disease on chronic peritoneal dialysis who benefited from kidney transplantation. The scheduled PD catheter flushes were marked by the drainage of ascitic fluid, leading to the postponement of the PD catheter removal. The ascites, thought to be secondary to his long-known cirrhosis, was refractory to optimal drug treatment and the PD catheter was used to remove ascites periodically. As a transjugular intrahepatic portosystemic shunt was planned, a severe aortic regurgitation was diagnosed. After aortic valve replacement, the ascites completely disappeared, and the PD catheter could be removed.DiscussionHeart failure represents only 3% of all refractory ascites. Furthermore, left-side heart failure causing ascites but without signs of right-side heart failure has only been described once in the medical literature. Patients with ascites and kidney failure on PD can safely be managed through the PD catheter instead of recurrent paracentesis. However, in transplanted patients especially, keeping the catheter in place brings significant infectious risk. ConclusionWe described an unusual case of refractory ascites after renal transplantation, due to aortic valve regurgitation. This case highlights the importance of weighing the pros and cons of early PD catheter removal, as PD catheter might be useful as a means of removing ascites.